Medicare Announces that it will Now Pay for Obesity Counseling
WASHINGTON, District of Columbia (MedPageToday.com and ABC News)—The Centers for Medicare and Medicaid Services (CMS) Medicare announced that it will pick up the tab for obesity screening and intensive behavioral counseling.
CMS, which first floated the obesity coverage plan last September, said it expects more than 30 percent of the Medicare population to qualify for the new benefit.

Beneficiaries with body mass index (BMI) values of 30kg/m2 or more can receive weekly in-person intensive behavioral therapy visits for one month, followed by visits every two weeks for an additional five months, fully paid by Medicare with no copayment.
Additional monthly sessions will be covered for up to six months afterward if the beneficiary has lost at least 6.6 pounds (3kg) during the first six months. The sessions should also include dietary counseling, the agency said.

Medicare patients who fail to lose the 6.6 pounds in six months may be re-evaluated at the one-year mark after the initial screening. Those showing “readiness to change” and a BMI value still at 30kg/m2 or more may receive another round of counseling paid by Medicare.

“It’s important for Medicare patients to enjoy access to appropriate screening and preventive services,” said outgoing CMS administrator Donald Berwick, MD, in a statement.

Counseling must take place in a primary care setting such as a physician’s office. It will not be covered when provided in skilled nursing facilities, hospitals, emergency departments, outpatient surgery centers, or hospices.

A primary care setting is defined as a setting in which there is provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.

To qualify under the new benefit, counseling must be consistent with the “five As” listed in a United States Preventive Services Task Force recommendation, according to CMS’s decision memo:
• Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
• Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
• Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
• Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
• Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

The agency had published the proposal to cover obesity screening and counseling under Medicare in early September, with a 90-day comment period to follow.

It based the decision on a review of studies and other evidence indicating that such counseling is effective in helping patients with obesity to lose significant weight, which in turn reduces risk of cardiovascular events and other adverse outcomes.

To read the full release, please visit http://www.medpagetoday.com/PublicHealthPolicy/Medicare/29940.

Obesity Action Coalition (OAC) Statement on the Impact of Obesity as a Factor in Child Neglect
TAMPA, Florida—Statement from Obesity Action Coalition (OAC) President and CEO Joseph Nadglowski:
“Today, there are more than 93 million Americans affected by obesity and one in three children is affected by childhood obesity. With the growing epidemic, reports of children being removed from their parents related to obesity are rare but becoming more common. The OAC encourages officials and the public to recognize the complexity of obesity before making determinations of parental neglect in such circumstances. The causes of obesity are numerous and much more complicated than child or parental behavior including societal, biological, genetic, and environmental factors. In addition, the treatment of obesity, especially in children, is extremely complicated and made very difficult by the lack of effective treatment options, lack of knowledge by the medical community and lack of insurance reimbursement for such services.

It is imperative that we, as a society, ensure that we are doing everything possible on all fronts in the fight against obesity, such as providing adequate and available healthcare, to make sure that America’s children are given the best quality of life possible before we begin deeming the disease of childhood obesity as parental abuse. The OAC is a National nonprofit charity dedicated to helping individuals affected by obesity. The OAC was formed to bring together individuals struggling with weight issues and provide educational resources and advocacy tools.”

For the full press release and for more information, please contact James Zervios, OAC Director of Communications, at (800) 717-3117 or jzervios@obesityaction.org.

American Society of Metabolic and Bariatric Surgery and The American Society for Gastrointestinal Endoscopy Issue White Paper on Endoscopic Bariatric Therapies—Societies Explore Role of Endoscopy in Treating Obesity
GAINESVILLE, Florida— The American Society for Gastrointestinal Endoscopy (ASGE) and the American Society for Metabolic and Bariatric Surgery (ASMBS) have issued a new white paper on the potential role of endoscopic bariatric therapies (EBTs) in treating obesity and obesity-related diseases like type 2 diabetes.

The white paper entitled, “A Pathway to Endoscopic Bariatric Therapies,” appears online in both Gastrointestinal Endoscopy (Gastrointest Endosc), the peer-reviewed scientific journal of the ASGE and Surgery for Obesity and Related Diseases (Surg Obes Relat Dis), the peer-reviewed scientific journal of the ASMBS.

According to the white paper, several EBTs are currently in different stages of development and include a wide variety of methods to induce weight loss and reduce obesity-related diseases and conditions.

EBTs are performed entirely through the gastrointestinal tract using thin flexible endoscopes and may offer patients an outpatient alternative to bariatric procedures including laparoscopic gastric bypass, adjustable gastric banding and sleeve gastrectomy.

“Endoscopic therapy has the potential to be applied across the continuum of obesity and metabolic disease,” said Bipan Chand, MD, chairman, ASMBS Emerging Technology and Procedure Committee, and co-chair of the ASGE/ASMBS Task Force. “However, it is generally expected that endoscopic modalities achieve weight loss superior to that produced by medical and intensive lifestyle interventions, have a favorable risk/benefit profile and have scientific evidence to support its use.”
The white paper addresses EBT treatment classification, potential indications, and efficacy including, primary efficacy endpoints, such as weight loss, definitions for weight loss, comparison of weight loss between therapies, threshold for weight loss, and study design; and secondary efficacy endpoints, such as reduction in obesity-related comorbidities, changes in quality of life, safety, durability and repeatability, adoption of EBTs in the context of global patient care, endoscopy unit considerations, training and credentialing, cost effectiveness, and government and industry relations.

To read the full white paper, see the November print issues of Gastrointest Endosc or Surg Obes Relat Dis. Visit www.giejournal.org or http://asmbs.org/soard/ for the online issues.

November 30, CMS issued a new directive that will allow nearly 15 million obese Medicare patients to see their primary care doctor for “free” up to 20 times in one year for face to face obesity counseling.

That’s potentially 300 million doctor visits which is 100 million more office visits then Medicare patients see their primary doctor now for all reasons. (There are nearly 50 million Medicare patients who see their primary care doctor an average four times a year). CMS set the reimbursement fee at $34 for each visit.

Do the math and this new unfunded benefit could potentially cost $10 billion.

Before CMS issued this memorandum, they did no actual cost benefit analysis; no estimate of the total cost of the program or whether this new service can even be delivered. (Isn’t there a well known projected shortage of primary care doctors?)

The Affordable Care Act gave CMS the power to do this which rivals anything Soviet era central planning ever tried to accomplish.

How is this new CMS benefit any different than when the Central Committee set wheat production goals by fiat and then set the price of bread without any concern if the wheat could be grown or the price of bread could cover the cost of production?

The best news about this CMS directive is that at a reimbursement fee of $34, most physicians won’t be too upset about being unable to deliver this service.

Oh, and how about the 33 million uninsured who are scheduled to flood the system in 2014?

The Affordable Care Act is an oxymoron if there ever was one. Remember when Pelosi said the bill would have to pass before we could find out what was in it? Surprise!

History of Bariatric Surgery

by Jacques Himpens, MD, PhD Watch the Video: Robotic Laparoscopic Cholecystectomy Jacques Himpens, MD, PhD, is an Associate Professor of Surgery at the European School of Laparoscopic Surgery and Chief of Bariatric Surgery at the CHIREC Hospital, Brussels, Belgium, and St. Blasius General Hospital, Dendermonde, Belgium. In 1977, he graduated cum laude from the Catholic […]

by Rafael F. Capella, MD, FACS Dr. Rafael F. Capella was a Clinical Assistant Professor of Surgery at the New Jersey Medical School of Newark, New Jersey, and a founding member of the American Society for Bariatric Surgery. He was a director of the Division of Bariatric Surgery at Hackensack University Medical Center at Hackensack, […]

by John G. Kral, MA, MD, PhD, FACS Professor of Surgery, Medicine and Cell Biology, SUNY Downstate Medical Center, College of Medicine and School of Graduate Studies, Brooklyn, New York. Dr. Kral is Professor of Surgery, Medicine and Cell Biology and former Director of Surgery at Kings County Hospital, Brooklyn, New York. He is past […]

Dr. Ricardo Cohen is the Director of The Center for Obesity and Diabetes at Oswaldo Cruz German Hospital in Sao Paulo, Brazil. He is also former President of the Brazilian Society for Bariatric and Metabolic Surgery. Dr. Cohen is a member of the Editorial Board for Surgery for Obesity and Related Diseases, Advisory Editor for […]

by Paul O’Brien, MD, FRAS Dr. Paul O’Brien is the head of the Centre for Bariatric Surgery in Melbourne, Australia, and Emeritus Professor of Surgery at Monash University. He was Head of the University’s Department of Surgery at the Alfred Hospital from 1986 to 2004. He founded the Centre for Obesity Research and Education (CORE) […]